Dr. Mayorga’s practice philosophy is based on the principles, which enable, patients to enjoy greater access to and more quality time with their doctor. Her practice is particularly suited for people seeking a doctor who will spend time with them to design a personalized plan for health.

Board certified in Internal Medicine and in Geriatric Medicine, Dr. Mayorga is a specialist in “Healthy Aging,” and has lectured and participated in community outreach programs. Dr. Mayorga collaborates with her patients to customize a care plan focused on their unique health needs and life goals.

Dr. Mayorga received a Fellowship in Geriatric Medicine from Rush-Presbyterian, St. Luke’s Medical Center, Chicago, Illinois. She completed residency in internal medicine at St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, and graduated with an MD from the University of Utah School of Medicine, Salt Lake City, Utah.

NCMA’s Internal Medicine & Geriatric Physicians diagnose, treat, and manage a full spectrum of health conditions. In addition to general internal medicine services, they also have expertise, special interest, and experience in gastroenterology, endocrinology, health screenings, diabetes management and care, immunizations, women’s health and much more. To schedule an appointment call 707.385.0222.

Dr. Gary Barth of ECI states, “We are really excited about having the Empire Eye Doctors group join us as it will provide our patients with even more choice in locations, easier access to quality eye care physicians, and more comprehensive medical eye care services.” Empire Eye Doctors are taking on the NCMA and ECI name and will maintain their current address, located at 720 4th Street in Santa Rosa. NCMA and ECI also have offices located at 1017 2nd Street in Santa Rosa and in Petaluma at 1383 McDowell Blvd #100.

NCMA and ECI offer a broad range of services to meet their patients’ vision needs. Their goal for more than six decades has been to improve, or restore their patients’ visual health. The list of services offered includes: Eye exams, cataract, and corneal surgery, glaucoma treatment, laser vision correction, cosmetic services, contact lenses, and full-service optical shops.

To schedule an appointment in the Second Street office please call (707) 546-9800, to schedule an appointment in the Fourth Street office please call (707) 575-3800, and to schedule in ECI’s Petaluma office call (707) 763- 6400.

Dr. John D. Tomasin, MD, a Northern California Medical Associates (NCMA) Orthopedic Surgeon discusses living with arthritis, exploring the latest research on the care of arthritis and explains when total-joint-replacement is necessary.

Research, led by the University of Warwick in the UK published recently in the journal Scientific Reports reveals that the first blood test for detection of early-stage osteoarthritis could soon be developed. Researchers who say that the biomarker they identified in the study makes it possible to detect the painful joint condition before bone and joint damage becomes obvious. Dr. John Tomasin, NCMA Orthopedic Surgeon, points out that this development will help to bring treatment for arthritis to patients when it could actually have the greatest impact; in the early stages of the disease.

Researchers suggest that this discovery raises the potential of a blood test that can help diagnose the most common forms of arthritis, RA and OA — as much as several years before the onset of physical symptoms. “With this sort of advanced warning orthopedic physicians would be able to manage and treat symptoms well before the disease reaches its more painful state and starts to become degenerative,” Tomasin says.

The sooner the diagnosis, the better — as most types of arthritis can be managed fairly well, and the pain and disability minimized when caught in the early stages. While it may be some time before advance detection is available by way of a blood test, treating arthritis as symptoms arise and knowing when to make an appointment with an orthopedic specialist will help to give patients a better outlook on living with arthritis.

Common Forms of Arthritis

It may surprise some people to learn that arthritis is the nation’s most common cause of disability affecting an estimated 52.5 million adults in the U.S; that figure translates to about 1 of 5 adults currently living with some form of arthritis. According to the Center for Disease Control, as the U.S. population continues to age, the number of adults with arthritis is expected to increase to a whopping 67 million by 2030.

Arthritis is most commonly diagnosed in adults 65 years or older but people of all ages – including children, can be affected. It tends to affect women more than men (26 to 19 percent respectively) of all racial and ethnic groups. Arthritis is thought to be caused by inflammation of the tissue lining the joints. More than 100 different category of rheumatic diseases and conditions exist under the umbrella of an arthritis diagnosis; the most common being osteoarthritis which usually develops are part of the aging process, and most often affects the fingers, knees and hips. Other forms of arthritis that occur includes:

rheumatoid arthritis

lupus

gout, pseudo gout

Arthritis is also more commonly diagnosed among adults who have issues of obesity, and is less likely to appear in those who maintain a healthy weight. There is no known cure for arthritis, but there are many treatments that can help slow down the condition and provide some relief. Symptoms universally include pain, aching, stiffness and swelling in or around the joints. Certain forms of arthritis such as rheumatoid arthritis and lupus, have been known to affect organs and cause pervasive symptoms throughout the body.

How Is Arthritis Treated?

Arthritis treatments are aimed at providing pain relief by controlling inflammation and increasing joint mobility. “Early, aggressive treatment is particularly important for rheumatoid arthritis in order to help prevent further damage and disability down the road,” explains Dr. Tomasin. Common treatment options may include medication, an exercise regime specific to the condition, application of heat or cold compresses and use of joint protection. When these methods fail to provide relief surgery may be considered.

When it’s time for Total Join Replacement

Total joint replacement is a surgical procedure where aspects of an arthritic or damaged joint are removed and replaced with prosthesis. This type of prosthesis is constructed from plastic, ceramic or metal and is designed to perfectly replicate the movement of a normal, healthy joint.

According to the American Academy of Orthopedic Surgeons the vast majority of patients report a significant decrease in pain following total joint replacement surgery; up to 90 percent of all patients. “Most patients quickly return to normal daily activities and are usually able to continue to stay active for years to come,” says Dr. Tomasin. “In many cases, following total joint replacement surgery we see our patients resume activities they enjoyed prior to being diagnosed with arthritis.”

A variety of conditions can cause joint pain and disability that lead patients to consider joint replacement surgery including damage to the cartilage that lines the ends of the bones called ‘articular cartilage’ usually due to arthritis, a fracture, trauma or some other condition.

It is reported that about 1 million total joint replacements were performed in the United States as if 2011. The most common type of joint replacement is hip and knee but replacement surgery can also be successfully performed on the ankle, wrist, elbow and shoulder.

About Dr. Tomasin

Dr. John D. Tomasin attended medical school at the University of California, Davis-School of Medicine, and completed his residency at the University of Mississippi Medical Center and the Scottish Rite Hospital for Crippled Children in Atlanta, GA. Dr. Tomasin completed his Sports Medicine Fellowship at Hughston Sports Medicine Clinic in Columbus, GA, as well as an AO Fellowship in Munich, West Germany. Dr. Tomasin has been published in numerous professional medical journals, including Journal of Bone and Joint Surgery, Journal of Orthopedic Trauma, and The Physician and Sports Medicine.
Dr. Tomasin has been the team physician for numerous high school athletic programs, including Healdsburg High School and Cardinal Newman High School. He is also been the acting medical consultant for the Northern California Rugby Football Union, and the team physician for the Santa Rosa Rugby Club.

Dr. Tomasin is committed to the health of the Sonoma County community, and he has been in practice in Healdsburg since 1988. To learn more visit our website or call 707-4330-0126 for an appointment.

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Resources:
First blood test for osteoarthritis could soon be available
http://www.sciencedaily.com/releases/2015/03/150320091317.htm

Arthritis: The Nation’s Most Common Cause of Disability
http://www.cdc.gov/chronicdisease/resources/publications/aag/arthritis.htm

Northern California Medical Associates (NCMA) welcomes Women’s OB/GYN Medical Group to its model healthcare organization. Women’s OB/GYN has built a first rate OB/GYN practice for Santa Rosa women and their families, and the practice is excited to offer patients access to NCMA’s full range of specialty health services.

Santa Rosa, CA July, 2014—In keeping with its goal of providing Northern California with a comprehensive network of state-of-the-art health services from leading specialists in a full-spectrum of medical fields, NCMA is proud to welcome Women’s OB/GYN Medical Group to its ever-growing practice. For nearly 25 years, Women’s OB/GYN Medical Group has offered a comprehensive selection of premier obstetrics and gynecology services to women in the North Bay Area. An all-women practice, Women’s OB/GYN Medical Group has fostered a safe, comfortable environment for women where practitioners fully comprehend patient needs and expectations. The practice offers an elite team of doctors, midwives, nurses, and medical assistants that coordinates care to provide unmatched OB/GYN health services to its patients.

Women’s OB/GYN Medical Group’s four elite physicians include Lela Emad, MD, Susan Logan, MD, Amita Kachru, MD, and Shazah Khawaja, MD. The doctors at this practice share in the whole-body care philosophy, meaning that they always strive to find the underlying causes of a woman’s health problems rather than simply treating the symptoms. Between the four of them, Drs. Emad, Logan, Kachru, and Khawaja carry specialty expertise in minimally invasive laparoscopic surgery, uro-gynecologic procedures, as well as general obstetrics and gynecology care.

The providers at Women’s OB/GYN also offer pregnancy care in collaboration with certified nurse midwives (CNMs). CNMs are specially trained in providing healthcare to pregnant women from conception through labor and delivery. Many women opt to have CNMs serve as their primary healthcare providers during pregnancy. Maximizing the birth experience and the health of newborns and their mothers is a CNM’s primary goal for pregnant patients. Achieving this goal requires expert knowledge about the gestation period and birthing process, as well as heightened empathy between providers and their patients. By working in close collaboration with the practice’s physicians, Women’s OB/GYN CNMs serve as the perfect health resource for pregnant women whom prefer to involve the personal touch of a midwife during their pregnancies.

Dr. Lela Emad, a board certified OB/GYN who first started Women’s OB/GYN Medical Group in 1990, explains, “I have always found NCMA to be a reliable referral source for my patients over the years, and it has been a pleasure working with and getting to know many NCMA doctors—some of whom have been in the area even longer than myself. All of us at Women’s OB/GYN Medical Group are excited to officially join NCMA, an organization that truly makes it easier for private medical practices to optimize their services for patients.”

Women’s OB/GYN Medical Group, located at 500 Doyle Park Drive, Ste. 103 in Santa Rosa, is currently accepting new patients. From pregnancy, menopause, minimally invasive surgery, incontinence, and regular gyn and breast health screenings, the team of health professionals at Women’s OB/GYN is committed to both alleviating patient ailments and maximizing patient long-term health. Visit www.womensobgynmed.com for more information on the practice’s services and providers.

To start care with a knowledgeable OB/GYN physician who will always treat you with compassion and expertise, call (707)-579-1102 to schedule an appointment today.

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Northern California Medical Associates is the premier provider of medical and surgical care north of the Golden Gate and has been serving individuals and families since 1975. In addition to OB/GYN health services, NCMA offers exceptional care in cardiology, cardiovascular/thoracic surgery, internal and family medicine, urology, vascular surgery, endovascular surgery, orthopedic surgery, general surgery, rheumatology, podiatry, pulmonology, ophthalmology, and otolaryngology (ear, nose, and throat). Every highly skilled professional comprising the NCMA team shares a strong commitment to preventive programs and health screening designed to promote and maintain everyday health. NCMA has successfully built a legacy of excellence that is recognized nationwide.

For a complete listing NCMA services and physicians in Sonoma, Mendocino, and Lake Counties, visit NCMAhealth.com.

Northern California Medical Associates (NCMA) Drs. James Leoni and Saw Aye are proud to welcome Family Nurse Practitioner Jessica Flinders to Petaluma Family and Internal Medicine Group. Jessica Flinders obtained her associates degree in nursing from the Santa Rosa Junior College before getting her Bachelor’s Degree in Science of Nursing from California State University in Dominguez Hills. She returned to school once more to earn her Master’s in Nursing and Family Nurse Practitioner from Sonoma State University, graduating in 1996.

Since obtaining her FNP, Jessica Flinders has independently provided full spectrum care to Petaluma patients as an important member of multiple private practices over the last 18 years working in pediatrics, primary care, and women’s health. Jessica is happy to return to primary care at Petaluma Family and Internal Medicine Group, where she has already become an integral member of the team working alongside Drs. Leonie and Aye.

Petaluma Family and Internal Medicine, located at 104 Lynch Creek Way, Ste. 10, Petaluma, CA 94954, is a part of Northern California Medical Associates (NCMA), Sonoma, Mendocino, and Lake counties’ premier provider of medical and surgical health services. To schedule and appointment with Petaluma Family and Internal Medicine Group, call (707) 782-9123, and visit ncmahealth.com for a complete listing of NCMA doctors and services available throughout the Northern California Region.

Bladder stones are exactly what they sound like; hard stone-like pieces of concentrated urine which have crystallized and clumped together. Interestingly enough, in developing nations bladder stones are fairly common in children – and sadly as a result of dehydration, infection and a low-protein diet. In the U.S. bladder stones tend to occur primarily in adults, and men over the age of 30 are the most vulnerable.

How stones get in the bladder

While water makes up the majority of urine content, about five percent is made up of minerals and salts along with proteins and other waste products. When urine becomes overly concentrated due to dehydration, infection or other problems the color will vary from dark amber to brown depending on the types of waste and minerals it contains.

Bladder stones can become so large or numerous that they block the tube (called a urethra) that urine flows through from the bladder. A blocked urethra may cause slow and/or painful urination or it might make urination impossible. Sometimes bladder stones cause no problems at all — even when stones become quite large. However, real problems begin to develop as stones irritate the bladder wall or block the flow of urine, causing a variety of symptoms including:

Pain in lower abdomen

Painful and frequent urination

Difficulty urinating or interruption of urine flow

Blood in urine

Cloudy or abnormally dark-colored urine

A variety of causes

In the case where prostate gland enlargement causes bladder stones in men, the urethra has become compressed by the enlarged prostate, which in turn interrupts urine flow, causing urine to remain in the bladder, leading to bladder stones.

Sometimes damaged nerves can be the culprit. In a healthy person nerves work to carry messages from the brain to the bladder muscles, telling the bladder muscles to constrict or relax. If these nerves are damaged due to stroke, spinal cord injury, Parkinson’s disease, diabetes, a herniated disk or other health problem – the bladder may not empty completely, again leading to bladder stones.

Bladder stones can also develop if the bladder becomes inflamed due to urinary tract infections or even radiation therapy to the pelvic area. Bladder catheters can also cause bladder stones as can objects that accidentally migrate to bladder, such as a contraceptive device or stent. When this happens mineral crystals tend to form on the surface of these foreign objects, leading to stones. And finally, stones that have formed in the kidneys can occasionally travel down the ureters into the bladder and, if not expelled by natural means, can grow into larger bladder stones.

Treatments

While medications are rarely used to dissolve the stones, drinking eight 8-ounce glasses of water or more per day will help to increase urination, which may help smaller bladder stones pass naturally. A qualified urologist will remove larger stones using an instrument called a cystoscope, which is a small tube that passes through the urethra to the bladder – and some more troublesome stones may need to be removed by surgery. For patients with enlarged prostate and bladder stones, transurethral resection of the prostate can be performed where the stone or stones are removed.

Prevention

The best way to prevent bladder stones from forming in healthy people is to be mindful to always stay hydrated and to seek early treatment for urinary tract infections or other urinary tract conditions.

Wintertime weather can affect more than just your mood; it can have a significant impact on your health as well – particularly if you are among the 50 million adults suffering from arthritis in the US. Dr. Jack Waxman of NCMA’s FountainGrove Rheumatology can help you understand and manage the symptoms associated with arthritis including those worsened by cold weather.

Anyone who suffers from arthritis pain can tell you that their joints do stiffen up as the temperature drops. And researchers have demonstrated in clinical studies that fluctuations in temperature or barometric pressure can have a very real effect on joint pain in arthritis patients, though they are still working out the exact reason for this phenomenon. For patients with arthritis the cold, damp weather can not only increase stiffness and joint pain it can also lead to increased anxiety, depression and isolation. Knowing when to seek professional help is an important factor in maintaining long term joint health and overall wellness.

Arthritis Pain – where does it come from?

The pain of arthritis can originate from a variety of sources. These may include;

inflammation of the synovial membrane (see below)

the tendons

or the ligaments

muscle strain

fatigue

cartilage degeneration

And, a combination of the above factors generally contributes to the sensation and intensity of the pain. Arthritis is a musculoskeletal disorder with many different causes. It is a disease that is not completely understood by experts, and according to the Arthritis Foundation, there currently are no cures. There are at least 100 different known musculoskeletal diseases or conditions that effectively destroy joints, bones, muscles, cartilage and other connective tissues, all leading to restricted physical movement of some degree. Winter weather can escalate symptoms and take its toll on arthritis sufferers in a many different ways.

How it Starts

In a healthy body, a membrane called the Synovium surrounds the joints and provides important cushioning. This membrane works to produce a small amount of thick fluid called Synovial Fluid that nourishes the cartilage, keeping movement fluid. The Synovium has a strong outer layer called the Capsule, which keeps the bones from moving too much. Whereas, ligaments are thick, strong bands usually just outside the Capsule located on both sides help to keep bones firmly in place. And finally, tendons, also located on both sides, attach muscles to bones. Their job is to hold the joint in place and help to move it.

Symptoms of arthritis are known to manifest in many ways, and it can be difficult to diagnose. It can come on slowly with only mild symptoms, or symptoms may appear suddenly, causing intense pain that escalates within just a few hours. Arthritis symptoms can also appear only occasionally over a long period of time. It might cause joint pain, swelling and stiffness, but it can also cause seemingly unrelated health problems like fatigue or a rash. In fact, early signs of arthritis are often mistaken for an injury or the result of over activity.

Common Types of Arthritis

Osteoarthritis (OA) is a progressive degenerative joint disease characterized by the breakdown of joint cartilage associated with risk factors such as weight (obesity), having a history of joint injury, and age. It affects nearly 27 million Americans, most over the age of 45.

Rheumatoid arthritis (RA), a systemic disease characterized by the inflammation of the membrane lining the joint causing pain, stiffness, a sensation of warmth, swelling and sometimes severe joint damage. It can also cause inflammation all over the body, affecting vital organs such as the lungs. In the U.S., an estimated 1.5 million people have RA and for some reason, there are 2.5 times as many women as men with the disease.

Some facts about this debilitating disease:

Rheumatoid arthritis affects 1.3 million people in the U.S., is typically diagnosed between ages 30 and 80 and also occurs in younger people

The chances of a person their 20s developing RA is 1 in 714 for women and 1 in 2,778 for men

Arthritis is the leading cause of disability in the U.S.

By 2030 an estimated 67 million Americans will have arthritis

Two-thirds of people with arthritis are under the age of 65

Arthritis and rheumatic conditions cost the U.S. economy $128 billion every year

How Arthritis Affects People

Joint health is an important part of every person’s sense of wellness, potentially impacting productivity, quality of life and independence. Taking steps to protect joints from ongoing pain and permanent damage caused by uncontrolled inflammation is important to everyone, and early diagnosis and treatment can actually save more than just joints. In this regard is may be helpful to know that NCMA’s Rheumatology provides comprehensive diagnostics, treatment and management of a full spectrum of rheumatologic health conditions for patients in the Santa Rosa region.

It is important to understand that arthritis pain affects people differently. Factors that can add to the pain a person may experience include the amount of swelling within the joint, the extent of heat or redness present and the damage that has occurred within the joint. Some patients report pain in their joints first thing in the morning while others may develop pain only after prolonged use of the joint. Everyone has a different threshold and tolerance for pain, and physical and emotional factors can also contribute to the sensations of pain.

Consult a Professional

If you are experiencing joint symptoms and are wondering if it is arthritis, then perhaps it is time to consult a doctor in your area. Because there are so many types of arthritis and such a variety of conditions that affect the joints, diagnosis can be difficult. Most people suffering from joint pain usually start with their primary care physician and are then referred to medical specialists called rheumatologists, experts in arthritis and related diseases.

Dr. Jack Waxman of NCMA’s FountainGrove Rheumatology is a highly skilled rheumatologist who is able to provide patients with diagnostics, treatment and management of a full spectrum of rheumatologic health conditions. In addition to general rheumatologic medicine services, treatment of arthritic diseases and fibromyalgia, vasculitis, connective tissue diseases, osteoporosis, bone density scanning and infusion therapy is also available. To learn more visit the NCMA website or call (707) 573-6942 to make an appointment today.

Dr. Molden earned his medical degree from the University of Chicago’s Pritzker School of Medicine, where he was recognized with the Dylan Award in Medical Ethics. Returning to California, and following internship and residency in internal medicine at Harbor-UCLA Medical Center in Torrance, Dr. Molden joined Kaiser Permanente Southern California in Los Angeles as an internist. In 2009 he completed a fellowship in cardiovascular disease at Harbor-UCLA Medical Center during which time he also served as a clinical instructor. Dr. Molden went on to complete the Clinical Cardiac Electrophysiology Program at Los Angeles’s Cedars-Sinai Medical Center in 2010.

Dr. Molden currently holds board certifications in clinical cardiac electrophysiology, cardiovascular disease, nuclear cardiology and internal medicine, as well as, advanced cardiac life support and has authored numerous clinical publications.

Cardiology and More

Dr. Molden is trained to diagnose and treat a variety of heart and cardiovascular conditions including congenital heart defects, congestive heart failure, heart disease, coronary artery disease, heart attacks, arrhythmias, high cholesterol, high blood pressure and many other heart-related conditions. As an electrophysiologist, Dr. Molden is able to also provide advanced diagnosis, treatment and management of electrical- based diseases and disorders of the heart. His education and experience in electrophysiology allows him to perform specialized surgical procedures such as ablation and drug therapy to manage complex arrhythmias.

By joining Northern California Medical Associates’ (NCMA) Cardiovascular Services team Dr. Molden becomes an important part of a highly recognized team of dedicated professionals, all working together to deliver the highest quality care with the best patient results. Providing treatment and services for everything from cardiac catheterization to open-heart surgery, from electrophysiology to rehabilitation and prevention, this highly qualified staff not only maintains its commitment to patient health and well-being, they also follow a tradition of excellence and expertise to deliver the most current, innovative treatment in cardiovascular medicine.

Making an appointment

Dr. Molden is pleased to be accepting new patients at NCMA’s Fountaingrove Cardiology office in Santa Rosa. For more information about NCMA visit our site at ncmahealth.com, and to arrange for an appointment call (707) 573-6199.

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Northern California Medical Associates is Northern California’s premier provider of medical and surgical care north of the Golden Gate and has been serving individuals and families since 1975. Every highly skilled professional comprising the NCMA team shares a strong commitment to preventive programs and health screening designed to promote and maintain everyday health. NCMA has successfully built a legacy of excellence that is recognized nationwide.